End of Life Care Flashcards
EoLC relates to a person expected to die within how long?
within the next 12 months
read JRCALC guideline ‘End of Life Care’
do it
Review the Gold Standards Framework Prognostic Indicator Guidance (2006). Briefly consider the reliability of tools such as the GSF PIG.
do it
pain assessment
VAS / FLACC
Abbey Pain Scale
Any recent changes in pain?
When, how & what were those changes?
Number of breakthrough (rescue) doses?
Non verbal cues?
Ask family / carers
consider what medications the patient is taking and their strengths.
Common EoL Symptoms
Dyspnoea
As a result of disease
as a result of treatment
as a result of other causes:
psychological: fear, anxiety.
Pre-existing cardiac or respiratory.
Reversible Oncological emergencies
Spinal Cord Compression
Superior Vena Cava Compression
Neutropenic Sepsis
Hypercalcaemia
Management of:
Malignant Spinal Cord Compression
TIME – potential neurological damage limited by rapid response
Attempt to call oncology / SPCT for advice
Analgesia
Extrication
- Limit movement
- Position – spine in neutral alignment
signs and symptoms of:
Malignant Spinal Cord Compression
Cervical: arm weakness, +/- pain, +/- power loss
Thoracic: Radicular pain (radiating into legs)
Lumbar: lower back pain, leg pain +/- weakness,
decreased anal tone, bladder retention
Signs and symptoms of:
Superior vena cava obstruction
Single most reliable sign is elevated JVP, non pulsatile.
Early: periorbital oedema, facial swelling
Late: Engorged H&N veins, increased oedema, plethora (excess of body fluid/blood), cyanosis
Severe: Headache, blurred vision, altered mental state, seizure
Management of:
Superior Vena cave Obstruction
Loosen clothing
Airway management
Sit upright/elevate head
Oxygen as per guidelines
Keep calm - ?patients own benzodiazepine
Signs and symptoms of:
Neutropenic sepsis
7-14 days post chemotherapy treatment BUT can be up to 6 weeks
Minor illness/feels generally unwell
Signs and symptoms of infection
pyrexia >38 requires urgent treatment
remember UKONS tool
management of:
Neutropenic sepsis
high index of suspicion
Call treatment unit
Follow sepsis guidelines
Signs and symptoms of:
Hypercalceamia
metastasis in bones: increased osteolysis (destruction of bone) increases calcium release
Hormone related
Think breast, lung or renal cancers with metastatic disease
Bone pain
Abdo pain, N&V, constipation
Renal stones, polyuria, polydipsia, dehydration
Fatigue, lethargy, anorexia, cardiac arrhythmias
VERY HARD TO DIAGNOSE IN THE PRE HOSPITAL SETTING
To convey or not to convey
Is it an EoLC reversible condition?
Where on their illness journey is the patient?
Can symptom relief be provided at home?
Has there been a change in social situation?
Could this be the dying phase?
HAVE YOU MADE A BEST INTERESTS DECISION?
WHAT DO THE SPECIALISTS ADVISE?
SHARED DECISION MAKING IS KEY: GP, APP, CHUB, 111, Hsopice, Patients palliative team
Medications administration
Paramedics CANNOT change / adjust a syringe pump
Paramedics CAN administer anticipatory medications as long as the medicines and authorisation chart are available in the home
The usual route of administration is subcutaneous (S/C)
Paramedics CANNOT accept verbal orders
Anticipatory Medicines
A signed authorisation chart must be present and authorised by an independent prescriber.
Includes information on each drug’s:
- Indication
- Dosage
- Frequency
Paediatric expected death guidance
EBS must be informed
Follow the child’s care plan if in place
Consult the child’s clinical team
Welfare for clinicians
Triggers
Bereavement by Exposure
Debriefing
PD33
STOP for 5 minutes S: summarise the case T: things that went well O:oppurtunities to improve P: points to action and responsibilities
Documents to review
Review LAS Guidance ‘Recognition and Management of Dying’
Review the subcutaneous medications administration video
Watch the AACE webinar ‘Compassionate Conversations’ (Start at 7 mins)
Read the JRCALC guidelines, ‘End of Life Care.’
Review the Gold Standards Framework Prognostic Indicator Guidance (2006). Briefly consider the reliability of tools such as the GSF PIG.
Review the LAS Guidance – ‘Medication at the end of life’.
Review the JRCALC guidance – ‘Morphine Sulfate for the Management of Pain in Adults at the End of Life’
Review the JRCALC Guidance – ‘Covid-19: Managing Symptoms (Including at the End of Life) In the Community’.
Review the LAS Guidance – Advance Care Planning.
Read the Mental Capacity Act Code of Practice.
Watch the ACP video on FB Live.
Things to help your decision making
A cancer diagnosis is not the only palliative one
Pause and think…… could it be EoLC?
Look for notes / CMC
Read notes
Advice and information from CHUB
Always call the specialists - they are there to help you!!
Think about what is the most appropriate care for your patient
